Preoperative evaluation of future remnant liver function by the contrast enhance ratio in hepatocellular image.

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1 Preoperative evaluation of future remnant liver function by the contrast enhance ratio in hepatocellular image. Poster No.: C-0564 Congress: ECR 2011 Type: Scientific Exhibit Authors: S. Matsushima, Y. Sato, H. Yamaura, M. kato, T. Kanamoto, Y. Kinosada, S. Era, H. Koyanagi, Y. Inaba ; Nagoya/JP, Gifu/ JP Keywords: Molecular imaging, Liver, Abdomen, MR, MR-Functional imaging, Contrast agent-other, Safety DOI: /ecr2011/C-0564 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 31

2 Purpose Preoperative evaluation of future remnant liver (FRL) function is crucial in the determination of whether a patient can safely undergo liver resection. Gd-EOB-DTPA is a newly developed MR contrast agent for hepatocellular imaging; it can be used as a tracer for liver function testing. We reported that the contrast enhance ratio in hepatocellular (CERH) imaging is a potentially useful method for liver function image by MRI. The purpose of this study is to evaluate of FRL function through the CERH imaging using Gd-EOB-DTPA. Images for this section: Fig. 1 Page 2 of 31

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4 Methods and Materials Design of this study for liver function image. Measurement data are MRI before enhancement, MRI of hepatobiliary phase (post CE 20 min), blood biochemistry data reflecting a liver function, fibrotic stage of liver. The following items were reviewed based on these data. The CERH value was defined as the percentage of signal up between the before contrast enhanced and hepatocellular images. The CERH images are the calculation images which did imaging of CERH value. #The significance between the CERH value and fibrotic stage of the liver. # Relations of CERH and liver function tests. #Threshold of CERH values detecting liver function abnormality. A utility of CERH imeges as liver function images was evaluated from the abovementioned results. Design of this study for FRL function image. Relations of CERH values and Remnant liver K-ICG in FRL. Methods and Material 76 patients with hepatocellular carcinoma were studied. 16 patients were operated for HCC. We adopted the contrast enhanced ratio technique for hepatocellular imaging to evaluate the CERH values. Hepatocellular images were imaged after an intravenous bolus injection of Gd-EOB for 20 minutes. The CERH value was defined as the percentage of signal gain between the before contrast and hepatocellular images. The CERH images were constructed on the basis of the percentage of CERH values. The CERH value measured the whole liver of non-cancer part without hepatocellular carcinoma, and FRL. We used liver function tests such as biochemical tests to determine threshold of CERH for detection of liver function abnormality. Threshold of CERH values detecting liver function abnormality were determined using the two-graph receiver operating characteristic analysis. Images for this section: Page 4 of 31

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14 Results No-fibrotic liver shows a higher CERH value, the CERH image is shown in red. On the other hand, liver cirrhosis shows a lower CERH value, the CERH image is shown in blue (Fig. 1). A statistically significant difference was obtained the CERH values of no fibrotic liver, hepatitis and liver cirrhosis (Table 1). The CERH value related to albumin, AST, ICG-15, PT(%), platelet billirubin, ChE by correlation coefficient (Table 2). A statistically significant difference was obtained the CERH values of fibrotic stage, #-GPT, billirubin, ICG-15, PT(%), platelet, ChE, albumin, LDH (Table 3). Figure 2 shows a correlation between CERH value and ICG-15. The CERH values threshold used to judge the presence of abnormal is predicted to be % ( sensitivity 0.83 and specificity 0.89) (Table 4). The good FRL function shows a higher CERH value, the CERH image is shown in red. On the other hand, the poor FRL function shows a lower CERH value, the CERH image is shown in blue (Fig. 4#Fig.6). Figure 7 shows a correlation between CERH value and remnant liver K-ICG in the FRL. The operative safety zone was shown with yellowish green. Images for this section: Page 14 of 31

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29 Conclusion ICG examination is considered to be an index of liver residual function. Problems of ICG examination are to evaluate the whole liver function. The CERH value related to liver function tests by correlation coefficient. The threshold of CERH value to judge the abnormal was about 121.1% from liver function tests by the two-graph receiver operating characteristic analysis. In the FRL, the CERH value related to remnant liver K-ICG. These results clarified that CERH values are parameters to show a FRL function, and CERH images are useful as a FRL function imaging to safely undergo liver resection. Images for this section: Fig. 1 Page 29 of 31

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31 References Remnant liver K-ICG Yasuhiro Kurumiya, MD, Masato Nagino, MD, Katsura Nozawa, MD, Junichi Kamiya, MD, Katsuhiko Uesaka, MD, Tsuyoshi Sano, MD, Shonen Yoshida, MD, and Yuji Nimura, MD, Biliary bile acid concentration is a simple and reliable indicator for liver function after hepatobiliary resection for biliary cancer.surgery 2003;133: Personal Information Page 31 of 31